Description of visits
Overall, 20.2% of the available estimated 925,686,657 visits (28,571 non weighted visits) were to specialists (Table , results for generalists included for illustrative purposes only). In one in four visits, the physician reported having seen the patient at least 6 times in the previous 12 months. This was the case in 50% of all visits to psychiatrists. Significant differences were observed by physician specialty group in age, sex, and insurance status of patients. Visits for medical specialists were similar in proportion of visits for female patients (47.2% vs. 53.9%), mean age (10.4 years vs. 10.8 years). The most frequent type of insurance in all visits was private insurance followed by Medicaid/SCHIP for all specialties, but there were significant differences between specialty groups. The proportion of visits for patients with private insurance was highest for medical specialists (76.7%) while Medicaid/SCHIP was highest among psychiatrists (29.6). Visits for psychiatrists were significantly longer than those for other specialties and there were also statistically significant differences in case-mix and mean number of diagnoses across the defined physician specialty groups.
Subsequent analyses are restricted to visits to specialists and where the focus of the visit was specialty care (173.968.435 estimated visits).
Routine follow-up in visits to specialists
Routine or preventive visits by known patients emerged as the most frequent type of visit, accounting for 71,896,865 estimated visits overall (41.3%), and for the great majority of all visits to medical specialists (51.2%) and psychiatrists (73.8%) (Table ). Visits for a new problem by a known patient were the most frequent among visits for surgical specialists (34.9%). Visits for new patients ranged from 1 in 10 for psychiatrists to 1 in 4 for medical specialists and 1 in 3 for surgical specialists. Only 2.2% of visits were in the category "Other".
Type visits and frequency of reappointments by physician specialty group (specialty care visits only).
Three specialties accounted for about well over half of all routine and preventive care visits: psychiatry (25%), allergy and immunology (17.8%), dermatology (11.7%). Comparatively, visits to these specialists accounted only for 34.9% of all visits when all visit types were considered. Seven diagnostic groups accounted as well for slightly more than half of all routine and preventive visits (52.7%) (Table ).
Expanded Diagnostic Clusters accounting for at least 50% of all routine visits to specialists for specialized care.
Referred and non referred care
The estimated 60,605,953 visits for patients referred from other physicians constituted a third of all specialty care visits (Table ). This proportion was highest for 39.9% for surgical specialists, followed by medical specialists (31.6%) and was lowest for psychiatrists (23.0%). Although there were no differences in gender, ethnicity and morbidity burden between referred and non referred visits, patients were significantly younger in referred visits (9.8 years vs 11.3 years, p < 0.05). Referred visits were longer than non referred visits (22.8 min vs 18.5 min, p < 0.05) also included a significantly slightly higher proportion of patients with private insurance (69.6% vs 66.3%, p < 0.05).
The most frequent reason for visit in referred care visits was a new patient (45.3%), while non referred care was most frequently for routine or preventive care (48.8%). Routine or preventive care for non referred patients was the most common type of visit, accounting for almost as many visits as all other categories of referred visits combined (55,367,121 vs 60,605,953).
Shared care and reappointments
Specialists reported sharing care for the patient with another physician in only 23.5% of all visits. Shared care was more likely to be reported in visits for referred patients than for non-referred patients (37.6% vs 16.2%, p < 0.05; adjusted OR = 2.90; IC95%:2.19-3.84).
A reappointment was scheduled in about 3 out of 4 visits. Overall, every 1 out of 2 reappointments resulted from a routine or preventive care visit (47.4%). The likelihood of a reappointment in referred visits was similar to that for non referred visits (71.6% vs 74.1%, p = 0.20; adjusted OR = 0.93; IC95%:0.76-1.14).